WASHINGTON (AP) — The Supreme Court on Thursday upheld the vast majority of President Barack Obama's historic health care overhaul, including the hotly debated core requirement that virtually all Americans have health insurance.

The 5-4 decision means the huge overhaul, still taking effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care.

The ruling hands Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they will try to use the decision to rally their supporters against what they call "Obamacare."

Stocks of hospital companies rose sharply, and insurance companies fell immediately after the decision was announced that Americans must carry health insurance or pay a penalty.

Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.

The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts said.

The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

Kennedy summarized the dissent in court. "In our view, the act before us is invalid in its entirety," he said.

The dissenters said in a joint statement that the law "exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding."

In all, the justices spelled out their views in six opinions totaling 187 pages. Roberts, Kennedy and Ginsburg spent 57 minutes summarizing their views in the packed courtroom.

The legislation passed Congress in early 2010 after a monumental struggle in which all Republicans voted against it. House Majority Leader Eric Cantor, R-Va., said Thursday the House will vote the week of July 9 on whether to repeal the law, though such efforts have virtually no chance in the Democratic-controlled Senate.

GOP presidential candidate Mitt Romney has joined in calls for complete repeal.

After the ruling, Republican campaign strategists said Romney will use it to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.

"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."

Democrats said Romney, who backed an individual health insurance mandate when he was Massachusetts governor, will have a hard time exploiting the ruling.

"Mitt Romney is the intellectual godfather of Obamacare," said Democratic consultant Jim Manley. "The bigger issue is the rising cost of health care, and this bill is designed to deal with it."

More than eight in 10 Americans already have health insurance. But for most of the 50 million who are uninsured, the ruling offers the promise of guaranteed coverage at affordable prices. Lower-income and many middle-class families will be eligible for subsidies to help pay premiums starting in 2014.

There's also an added safety net for all Americans, insured and uninsured. Starting in 2014, insurance companies will not be able to deny coverage for medical treatment, nor can they charge more to people with health problems. Those protections, now standard in most big employer plans, will be available to all, including people who get laid off, or leave a corporate job to launch their own small business.

Seniors also benefit from the law through better Medicare coverage for those with high prescription costs, and no copayments for preventive care. But hospitals, nursing homes, and many other service providers may struggle once the Medicare cuts used to finance the law really start to bite.

Illegal immigrants are not entitled to the new insurance coverage under the law, and will remain one of the biggest groups uninsured.

Obama's law is by no means the last word on health care. Experts expect costs to keep rising, meaning that lawmakers will have to revisit the issue perhaps as early as next year, when federal budget woes will force them to confront painful options for Medicare and Medicaid, the giant federal programs that cover seniors, the disabled, and low-income people.

The health care overhaul focus will now quickly shift from Washington to state capitals. Only 14 states, plus Washington, D.C., have adopted plans to set up the new health insurance markets called for under the law. Called exchanges, the new markets are supposed to be up and running on Jan. 1, 2014. People buying coverage individually, as well as small businesses, will be able to shop for private coverage from a range of competing insurers.

Most Republican-led states, including large ones such as Texas and Florida, have been counting on the law to be overturned and have failed to do the considerable spade work needed to set up exchanges. There's a real question about whether they can meet the deadline, and if they don't, Washington will step in and run their exchanges for them.

In contrast to the states, health insurance companies, major employers, and big hospital systems are among the best prepared. Many of the changes called for in the law were already being demanded by employers trying to get better value for their private health insurance dollars.

"The main driver here is financial," said Dr. Toby Cosgrove, CEO of the Cleveland Clinic, which has pioneered some of the changes. "The factors driving health care reform are not new, and they are not going to go away."

Justice Ginsburg said the court should have upheld the entire law as written without forcing any changes in the Medicaid provision. She said Congress' constitutional authority to regulate interstate commerce supports the individual mandate. She warned that the legal reasoning, even though the law was upheld, could cause trouble in future cases.

"So in the end, the Affordable Health Care Act survives largely unscathed. But the court's commerce clause and spending clause jurisprudence has been set awry. My expectation is that the setbacks will be temporary blips, not permanent obstructions," Ginsburg said in a statement she, too, read from the bench.

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Just what I said from day one. The health care mandate is not really a commerce clause issue. Its a GENERAL WELFARE issue, which Congress has the power to tax and regulate under Article I Section 8. If people would get their head out of their rears and read and research, they would understand that this was debated 70 years ago in the Helvering v. Davis case regarding Social Security. As long as it is a TAX, it promotes the GENERAL WELFARE, and applies to ALL AMERICANS, it is constitutional. Its the same exact clause that allows Congress to waste trillions of dollars on national defense.

[i]"Where are you going to put all the " I ain't buying no flippin insurance" offenders??? "[/i]

The Health Care Law had no penalty that could be brought against anyone that ignored the mandate (as it was written) but now if it can be considered a tax it would seem that a penalty could be levied against someone in the same manner as if you had not paid your income tax.

Ok, it's Constitutional. This November a Constitutionally mandated election will occur. After this decison there is no way around it; the election will be a referendum on the President and legislators that voted for the bill as well as the economy. Neither of those issues will be good for the incumbents. I doubt there will be enogh votes to repeal this bill anytime soon, if ever, but hopefully we can channel the energy into electing folks that can amend it

Can all of you 'right' wing nuts (including SMN) start calling the law by it correct name now !!!!!
The Affordable Care Act not Obama care.
Congress passed this act not Obama, and it was upheld by Supreme Court. Get over it.

[i]"I wonder how many old Tea Partiers are in the ER right now, having heart attacks at this news, and billing their treatments to Medicare while decrying socialized medicine?"[/i]

The Tea Party Republicans can be expected to wail for some time but many Republicans, especially those up for reelection with constituents who may have opposed the law but liked many of it's parts, will make a token show of indignation only.

[i]And I say unto you, That many Tea Partiers shall come from the east and west, and shall sit down with Boehner, Cantor and Ryan, in the Republican halls of Congress. But the children of the Republican halls of Congress shall be cast out into outer darkness: there shall be weeping and gnashing of teeth[/i] - Chief Justice John Roberts /sarc

I agree that the IRS will collect the tax for not having insurance, but I wonder how the IRS will confirm if a person has insurance. Also what if I am low income or no income, and normally have no tax liability, but by not having insurance the penalty creates a tax liability that I cannot pay? I imagine there will have to exemptions for some people. I thought you might have an idea based on your posts you seem to know more about this.

will be upset by this ruling. Anyone who puts Liberty first will be saddened by the ruling, but this is how our government works. The Supreme Court is the final arbiter of our laws and they say it is Constitutional. Even if the law were repealed that does not change the Constitutionality of the law, or the fact the Congress can now apparently regulate pretty much anything as long as they attach a tax to it. It is now more important than ever to elect representatives that will not abuse this new ruling to limit individual liberty even further.

If you can't afford insurance, how can you be forced to by insurance?? There are unemployed people out here with families that can't even get food stamps or financial asistance now!! How can you mandate that these people get insurance or be penilized for it?? What sense does that even make?

"It has been urged and echoed, that the power "to lay and collect taxes, duties, imposts, and excises, to pay the debts, and provide for the common defense and general welfare of the United States," amounts to an unlimited commission to exercise every power which may be alleged to be necessary for the common defense or general welfare. No stronger proof could be given of the distress under which these writers labor for objections, than their stooping to such a misconstruction." -J. Madison Federalist # 41

The real crying will come from the libs when the largest tax in American history becomes real and then continues to get larger every year until everything you own will be taken to satisfy your new tax liability all the while watching as the drug companies, and others, get richer and richer from their backroom deals with the devil. And as our one premier health system slowly degrades just as it has elsewhere in the world. With this ruling the Supreme fools have converted every American to slave status. There will be nothing barred in the future to take every last cent from people and dictate every move you make. And to all of the poor people, just how long do you think your gravy train is going to run? At some point you will bear the brunt of your inaction. When will all Americans wake up and realize we have a common thug among us that is systematically stripping all of our freedom away. That thug is the Federal Government. Wake up People.

You Constitutional Scholar, Mirv5000. My only hope is you were watching Fox or CNN as the decision was read. Bet ya got your hopes up! I'm sure all you Tea Partiers were watching Fox. Their expressions were priceless!!!

A tax. Not even anything to do with Commerce Clause. Exactly how the Administration argued the case. Beautiful!! It's like he understood the Constitution or something.

It appears, after reading a good portion of the majority opinion, that the penalties, such as they are, will remain as they were described in the original bill. The only things that were considered and spelled out in the majority decision is the mandate and the Medicaid expansion, the latter which was struck down.

[i]For individuals who choose to not comply with the individual insurance mandate, Congress deliberately chose to make the penalty fairly weak: only $95 for 2014; $325 for 2015; and $695 in 2016.

After 2016, that $695 amount is indexed to the consumer price index.

Congress specifically did not allow the use of liens and seizures of property as methods of enforcing the penalty.

Non-compliance with the mandate is also not subject to criminal or civil penalties under the Tax Code and interest does not accrue for failure to pay the penalty in a timely manner, according to the congressional Joint Committee on Taxation[/i].

I would assume in the law that where mandate appears this will now read tax but unless they change the wording as to what type of monetary punishment for non-compliance the amounts shown above will stay as they are. If punishment for not complying stays the same then there really isn't any real punishment.

That is actually a good point you raised. The constitution forbids Congress from seizing property to enforce most penalties, its the reason why 50 acres and a mule never happened after the Civil War. Taking southern property was unconstitutional, even though they rebelled against the nation.

The original Social Security Act describes non payment as a penalty and not a tax. SSA was also declared Constitutional in 1937 just like the Health Care Act was today, and they never changed the language. So I will assume penalty will still be used instead of tax for non-payment.

Actually Justice Roberts addresses that issue on page 39 of his opinion; essentially why he decided in favor of the law in spite of the wording:

[i]"Suppose Congress enacted a statute providing that every taxpayer who owns a house without energy efficient windows must pay $50 to the IRS. The amount due is adjusted based on factors such as taxable income and joint filing status, and is paid along with the taxpayer’s income tax return. Those whose income is below the filing threshold need not pay. The required payment is not called a “tax,”a “penalty,” or anything else. No one would doubt that this law imposed a tax, and was within Congress’s power to tax. That conclusion should not change simply because Congress used the word “penalty” to describe the payment"[/i].

How I read it is that regardless of how the bill was written up the penalty is still a tax. He reaffirms this in his example and closes that aspect of the argument with, [i]"That conclusion should not change simply because Congress used the word “penalty” to describe the payment"[/i]

Because they (Congress) screwed up on the wording should not lead to the law being struck because the very nature of the penalty should have been and is implied by it's nature as a tax.

And since Congress can levy a tax on just about everything and be within it's authority to do so...bingo.

Very interesting, I think the IRS is smart enough to find a way to get their money from most people though. I bet they will apply your withholding tax / estimated tax payments to the mandate first if you are uninsured thus making any liability an income tax liability that they can pursue and apply penalties against. It will be difficult to collect from those with no income. Lots of nasty letters will be sent though. I imagine their liability will just accumulate and never go away. Regardless I appreciate the thorough response. After I posted I thought I might have unintentionally put you on the spot.

Never on the spot. If I can't think of a reasonable explanation to a sensible question, regardless of it's difficulty, I would have done what most on here does... jumped on my horse and got out of Dodge! :)

Actually I love this type of stuff even though it's complexity sometimes can make it a challenge to comprehend.

I would agree with you but only if we could put an insurance agent at every doctor's door and at the entrance to every hospital and clinic and demand purchase of insurance before admittance.

In lieu of this, and also because I believe that the 'pursuit of happiness' is a noble one but only if you are healthy enough to get in the race and also since probably like you I don't cherish the thought of having to pay for other people's health problems simply because they choose not buy insurance, I am satisfied with the court's decision.

I love this stuff too. Though I prefer economics over politics and government, but try finding someone worth debating the fate of the euro with. It is also nice to find someone you can debate with rationally after an incredibly divisive matter is resolved. Honestly I thought the boards would be filled with ugly comments today. Granted the day is still young. Enjoy the victory it will probably stand. The only thing left is to determine is the price tag. A payment was made in November of 2010. We will see this November if that was payment in full or the first installment. Even if Republicans win in the Fall it will be a small victory compared to the one Democrats got today. So savor the moment. BTW, I agreed with your comments on the George Will editorial this morning. I was surprised the ruling was 5 - 4 there. It seemed to me there would be more consensus.

Congress and the president swore up and down that the mandate was not a tax. What Congress said the individual mandate is, the Court said is not constitutional. What Congress said the mandate is not, the Court ruled is constitutional. Really?

Remember 1776 and the years that followed. We finally rid ourselves of a despotic self-serving government and established our Constitutional Republic. We did it then and we can do it again. While the weak are enjoying their unearned but short term freebies, the strong and determined will be preparing and keeping their powder dry.

Those of you who are wallering in your hollow victory now, please enjoy it now while it lasts. But remember, you will be begging for scraps later. You are not winners, but victims of your own folly.

...collecting on bets and gloating. Not only did I get it right that the mandate and most provisions would be upheld, but I also got it right that the basis would be under the taxing powers, not the Commerce Clause. I was however wrong about the swing vote. Thought it would be Kennedy. Pleasantly surprised that it was Johnny Roberts, the ultimate corporate lawyer.

As a result, I got a few nice cigars and an old bottle of Bordeaux coming my way! Thanks John!

...the law was passed by the Congress, signed by the President and held to be constitutional by the Supreme Court. That is what our Constitution demands of a law. Your reference to despotism is misplaced.